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"__ OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit <br /> No. 76 <br />,..... , .... :............... .................. (Complete In Triplicate? �. ; <br />..... .. .............................................. Date issued <br /> This Permit Expires t Year From Date Issued <br /> >'Appllcatlon is hereby made to the SSR cam Ilanocal Health <br /> District forOrdinance permit <br /> t and ex ng ttulestand Regutaall the �tins=ein y <br /> 'described. This application Is made p ', a and e tsti <br /> ` CF�1Sl� RAC <br /> S�T .. ... <br /> s JOB ADDRESS/LOC TN . Phone.. . �'.--�_ .. <br /> Owners Name . .. ...�.. •: l ....... . ..: .. ...... .. ................ i <br /> �. <br /> Address : --•_=• .? ...:�:.P. ... <br /> ........... <br /> r �_..a.��. ... Phone <br /> Contractor's Name _ <br /> ........... ......License # •., <br /> esidence <br /> R <br /> Commercial)]Trailer Court 0 , <br /> Installation will serve: Apartment Hous ] <br /> Motel 0 Other ` <br /> Garb............. <br /> age Grinder ------....._ Lot Size <br /> ' Numlaeir of living units:............ Number of bedrooms .....�.------, private �� <br /> Water Supply: Public System and name _.. <br /> -------------••-----._.-----F.__�...t_._..------ ....... <br /> ---- ................................... <br /> Slit❑ Clayi: ❑ 'Peat 0—tandy,.Loam. COW Win!Irl . r <br /> Character of sail to a depth of 9 feet= Sand El y "- -- <br /> IL <br /> Hardpan® Adobe C❑' fill Material ............If yes,type'4? ................ <br /> (Plot pian, showing size of lot, location of system in relation .to wells, buildings, etc. mvOi be placed on reverse side.)cl <br /> It rmitted.lf,public sewer is evadable within 200 fbet,) <br /> NEW INSTALLATIONS (No septic lank or seepage p pe , .p <br /> I + ,. gyp <br /> - I I � . �liqu[d Da ih.. ----• <br /> Size_:. � ............... i <br /> PACKAGE TREATMENT ( I SEPTIC TANK t I `..... - - -- ,......--- <br /> � �� yp � material.... .. ............ No. Compartments .._....._. <br /> Capacity c T e 0 <br /> We r. N ndation ./4P............... Prop. Line ............... <br /> • Distance to nearest. l ............ - u r h� _ _ r <br /> I Ilne tid ' ^` t.Tatal�.lengt ........... ........ <br /> Length of eachr ;, <br /> r LEACHING LINE [ I No. of Lines ......##V <br /> Filter Material .. '. DeptWilter Materlal .`-�_--�..• <br /> 'D' Box ..�........ Type J .� ! I .... property Line ..................... <br /> Distance to nearest: Well ...................... ' Found&tlon ..._......_. ... aPe <br /> � w <br /> .._....i..... Rock Filled Yes'❑ o C3 <br /> . Diameter Number Fill <br /> SEEPAGE PIT E D Depth -----.. -••----•---•---• --- <br /> F. Water Table Depth --------- -----•- ...............................i ock Size :�.._.. ... ... <br /> r C--..__. .Fa�nciation yProp. Line ---•.....-•......•... <br /> r Distance to nearest: Well ..... <br /> r•' ,-•. . <br /> - � � .�.�-_ Date ..............................�) <br /> RI:PAIR/ADDITION(Prey. Sanitation Permit lit .....................•••---..---•.s•j• r f .. ........_................. <br /> Septic ink (Specify Requirements! ------•-•................................ .�._..,......................... ..'. .�. <br /> __...+. r ..T. .._... <br /> ,. <br /> . 1'J . ....... - <br /> Disposal Field (Specify Requirements) -•••••....... .. ............. ... i <br /> ....-•-• .........I............... --....----•--••"-.........:.................... --• .............. ............. .... <br /> :. .. <br /> ................ i ._ ............ ........ <br /> •---•---.... <br /> •---....... ...._......�_... . _ ..... :............ ..,__.. • -- <br /> 1 (Draw existingand required addition on reverseside) <br /> qvin <br /> I hereby certify that I have prepared this app licatio and tof th6 San Joaquin WQIa Hoa th District Home hat Ae; work will be done Ill accordance towner oh Sulk r HOW <br /> County Ordinances, State Lewis, and Rules and Regulations ; <br /> sed agents signature certifies the`following: ''" <br /> s certify that in the performance of the work for his permit is issued, I shall not employ any�per n In sutl+ihanner <br /> as to become subject to orkman's ompensation laws bf Californl " <br /> .--. Owner <br /> �. Signed ��r...- •.�................. ................................ --..... -.••-.-•- <br /> ` - -- Title ..................................... ......... <br /> ................................. <br /> � .............................. GRD •- .. <br /> (If other than owner) <br /> I F RT T USE ONLY [' <br /> r .. .. <br /> ' ........ . . .....•-•..., DATE .��.:-. <br /> APPLICATION ACCEPTED �BY DATE........................ ......... <br /> ---........ <br /> BUILDING. PERMIT ISSUED ... .._ ................*..........--•.--- <br /> ADDiTiONAt COMMENTS CAW4W. J ' � ` <br /> ................................ .......__..__....... __ ,r.,....... . ........_..I.............. .....I......:..._. ..�...... <br /> .._.. . ..... Date .......... ... <br /> Final Inspection by: <br /> EH 13 24 1-613 Rov. �M SAN IOAQUIN LOCAL HEALTH DIS>R1CT 8/7h 3M <br />